Thursday, April 27, 2006

It's not until one washes one's hand three trillion times per day that one truly appreciates the drying effects of water. It's Saharian in its drying capacity. However, one can certainly understand how a patient who is told that she needs a wet dressing in order to dry a seeping wound might raise an 80-year old eyebrow and toddle off to the pharmacy to buy some more minty-cream.

NewFNP was happy to take a look at her patient's wound yesterday. In fact, when newFNP was in her whirlwind med-surg rotation, she was somewhat of a wound guru. Well, folks, those days are long-fucking-gone. As newFNP unwrapped the homemade bandage and caught a whiff of the minty salve, she began to realize the extent to which one year of untreated wound festering can wreak havoc upon delicate ankle skin. What began as a "vein" that she scratched with her shoe turned into a large - let's say 5 inches in diameter - ulcer covered with thickened yellow necrotic tissue.

She has been using all matters of salves and creams for the past year, all leaving her unfulfilled and with a growing lesion. The scent of the cream she was rocking in clinic yesterday was reminiscent of kindergarten paste and she had applied it just as thickly as would a 5-year old. She told me, with utter contempt, that one doctor told her that she should just cover it with water and that it would heal. The tone in which she conveyed this story implied, "As if."

When newFNP prescribed the exact same treatment, she wrote the kindly old lady a prescription for sterile water and told her that she needed to use this "special water" to heal her wound over the course of the next year.

Monday, April 24, 2006

Hours worked: 8Number of patient visits: 27Number of complete physicals: 6Number of IUD insertions newFNP did for the first-ever time: 1Number of third-graders weighing in at greater than 100 pounds: 2

Number of weeks of vacation newFNP currently receives through her clinic: 2Number of sick/personal days: 4 - total, not each.

Sure, newFNP understands that she earns approximately 10K under market because she works in community health. Sure, she is savvy enough to reason why she is forced to see so many patients day in and day out.

But what newFNP does not understand is why her clinic's management does not seem to address the concept of "burn out" and spend some time considering what it might do to prevent it from happening to its employees. All newFNP wants is 4 weeks of vacation per year. Yes, it's a lot. No, it is not at all unreasonable.

NewFNP suggested this change to the doc with whom she works, who in turn suggested it to senior management. NewFNP is anxiously awaiting their response. Her passport is current and aching for some new stamps.

Thursday, April 13, 2006

Ah, fashion. NewFNP loves fashion. NewFNP loves shopping. Just to descend into the warm embrace of the Prada SoHo, to flirt with the sassy Sigerson flats, to luxuriate in the sensation of a Theory cashmere sweater against one's cheek - even at the outlets! NewFNP loves it all.

There are, however, some fashion trends newFNP just can't endorse. These include MC Hammer pants. Can't touch this? Yeah, no shit - who would want to with those baggy ass yellow trousers? Also on the list are jelly shoes, even Marc Jacobs jellies. A current fashion forward look which newFNP finds revolting are the gladiator sandals. Go away with your leather ties up your legs. It's ugly and slutty looking.

A look that has likely not graced the pages of Vogue or Marie Claire in some time might be the half-shirt. As fashion forward newFNP readers know, longer tees are in. Bare midriff - out.

Apparently, our 275-pound walk-in yesterday morning didn't get the memo. She also must have missed the memo that it is important for breast health to wear a bra. She clearly missed the memo stating that one's ample bosom belongs inside one's half shirt as opposed to hanging out of the bottom, nipple pointing directly to the floor.

Is newFNP wrong, or is it very unusual for a woman to bear her nipple in public? Granted, newFNP lives in a rather progressive city where the climate is mild and where boobs are an important accessory. Nonetheless, it is newFNP's opinion that one must be utterly divorced from reality to A) find it acceptable to share one's lady-goods with all of the clinical staff and patients or B) not realize that one's nipple is actually out of one's shirt! I mean, come on, isn't it even a little cold? Isn't there a breeze with which to contend?

Bottom line: newFNP is no conservative, but she votes to keep the nipples in the shirts when in public.

Friday, April 07, 2006

When newFNP has a pain that self-resolves, she is thankful and happily moves on with her life. That is not the case, however, for many of newFNP's patients. I cannot begin to tell you the frequency with which I hear of bygone aches and pains, now entirely resolved.

So you say that your back hurt 3 months ago? Interesting.

What's that? You had a headache last year, just once and then it went away? Well, aren't you a medical miracle.

Pardon me? What caused that pain you experienced last July? NewFNP must confess, she'd be hard pressed to say.

Lest anyone think that newFNP is an asshole, she does in fact inquire as to whether there are any other health concerns that might have brought the patient to the clinic. Most frequently, the answer is no. Sometimes, however, there is another chief complaint.

One such example is my mid-30's male patient who segued from resolved pain to constipation. Ah, poop. Now there is something you can really assess and sink your teeth into during the history-taking!

For instance, when was your last BM? Today.

I see. And how often do you have a BM? Every day. Twice a day.

This is the point during which newFNP questions her Spanish skills. Twice a day? Constipation? Something is not adding up!

OK, well, twice a day falls well into the range of normal...

At this point, newFNP's patient won the Brown Star Award when he disclosed his normal bowel pattern of three movements per day. Maybe the day after Thanksgiving, but every single day?!?

As newFNP sees it, Mr. Poopie has just saved himself an estimated roll or two of TP per month, not to mention an estimated 30-45 minutes per week away from the throne.

No, newFNP is not here to complain about salary, although it is too little to support major urban area rent, plus shopping - and not even at Barney's, plus student loans. No, at this point, it seems as though newFNP's clinic has bigger fish to fry.

You see, as in many other metropolitan areas, newFNP's metropolitan area has a significant population of uninsured people. NewFNP's clinic offers 100% free services to these people, including the dispensing of some medicines. No, we do not offer Botox, but we will do our part to keep a patient's A1C at a reasonable level. As such, newFNP's community health clinic in positively out of money for uninsured patients. Imagine newFNP pulling her empty pockets out of her flattering Theory trousers, shrugging all the while, and you'll get the idea. The well is dry.

So, what next? How does newFNP provide an acceptable level of care to these patients if she can neither order labs nor dispense meds? NewFNP is already sensitive to the financial strains of community health practice. Should newFNP provide more thorough care to her insured patients than she does to her uninsured patients? The thought is unsavory at best. And unethical, according to newFNP's ethics.

Our finance department has placed a stop on all of our orders as a result of these dire straits. How much has this administration spent on Iraq, Afghanistan and the bullshit Social Security overhaul? How much was spent on a certain state's special election in 2005? How much do the Boston Celtics earn collectively? NewFNP will tell you what - it sure as fuck wouldn't take billions to keep our patients healthy.

So far, newFNP's clinic remains relatively well stocked. However, if we run out of gloves, newFNP is placing a moratorium on all rectal exams. Hey, you've gotta draw the line somewhere.

This blog is for new NPs or NP students who want some real 411 on the life of a new practitioner. A new practitioner in a busy, understaffed, urban community health clinic in a major metropolitan area. Oh, and newFNP swears while writing and, sometimes, while working although she tries to keep those swears to herself. Consider yourself warned.